In the immortal words of Mark Twain, “The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.” But in today’s world, it seems dying itself has become a bureaucratic conundrum, steeped in debates about autonomy, morality, and whether societies are ready for the weight of such decisions.
As the UK House of Commons debates its historic Assisted Dying Bill, the global conversation on euthanasia and assisted dying has reignited. While advocates push for dignity in death, skeptics argue that this shortcut is being considered before fixing the glaring gaps in palliative care, especially in countries like India.
Is assisted dying an overdue recognition of human dignity, or are we putting the proverbial cart before the horse, ignoring the basic right to quality care before death?
Assisted Dying: A Global Cheat Sheet
Let’s start by clearing up some linguistic clutter. Assisted dying is essentially giving terminally ill patients the legal and medical tools to end their lives, usually through prescribed medication. Euthanasia, on the other hand, is a slightly heavier affair—it involves someone else, typically a doctor, administering life-ending procedures.
The UK’s Assisted Dying Bill restricts this right to terminally ill adults expected to live less than six months. Advocates argue it’s humane, giving patients control over their suffering. Critics counter that this opens a Pandora’s box of ethical dilemmas, especially in systems where inequality already makes healthcare a privilege rather than a right.
Globally, the situation is patchy. Countries like Belgium and the Netherlands embrace euthanasia with wide arms, even for non-terminal conditions. Switzerland has been offering assisted dying for years, so much so that “suicide tourism” has become a thing. In Canada, the Medical Assistance in Dying (MAID) law includes non-terminal conditions, sparking heated debates. Meanwhile, parts of the US like Oregon and Washington have limited assisted dying programs focused on terminal illnesses.
Contrast this with India, where even a decent painkiller can sometimes feel like a luxury item.
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India: Where Dignity in Death Is Still a Luxury
In 2018, India took a cautious step by legalizing passive euthanasia under specific guidelines, allowing the withdrawal of life-sustaining treatments for terminally ill patients in a permanent vegetative state. But assisted dying and active euthanasia remain off the table. Frankly, we’re still figuring out the basics: food, shelter, and access to antibiotics. Talking about euthanasia before fixing palliative care here feels like discussing dessert options at a party where guests haven’t been served the main course.
India’s healthcare system doesn’t exactly scream “ready for assisted dying.” Palliative care—end-of-life support that manages pain and offers emotional solace—is abysmally inadequate. Only 1% of those in need have access to it (Lancet Commission report 2017). Kerala stands out as an anomaly, with a robust community-driven palliative care model, but that’s more an exception than the rule.
For a country home to 18% of the global population, this gap is not just a failure of policy but a glaring moral blind spot. Imagine having to endure unbearable pain or suffering, not because medical solutions don’t exist but because they’re simply out of reach.
The Economics of Suffering
Let’s address the elephant in the room: cost. Quality healthcare, including palliative care, is expensive. The argument that “assisted dying is cheaper than long-term care” has been whispered in the hallways of health economics for years. While no one explicitly says it, the fear that legalizing assisted dying might prioritize economic efficiency over compassionate care is a valid concern.
Take Canada’s MAID program, for example. While it has expanded access to assisted dying, there are cases where individuals have opted for it not because they wanted to die, but because they couldn’t afford to live. According to The Wire based on a NITI Aayog report, if we transpose this model to India, where nearly 10 crore people are pushed into poverty each year due to healthcare expenses, the outcome could be disastrous.
A Tale of Two Ends
Proponents of assisted dying argue that it’s not about replacing palliative care but complementing it. After all, even the best palliative systems can’t alleviate existential suffering or restore the dignity lost in one’s final days. And they’re not wrong. Studies in places like Oregon show that while only a small percentage of terminally ill patients opt for assisted dying, knowing they have the option offers immense psychological comfort.
But there’s a problem when this choice exists only for the privileged few. Imagine an India where urban elites have the luxury of a dignified assisted death, while rural populations continue to die in agony, not from terminal illnesses but from the lack of basic healthcare. It’s not a question of whether assisted dying is right or wrong—it’s about whether we’re creating yet another system where inequality defines access.
The Slippery Slope and the Grey Areas
The slippery slope argument is often dismissed as alarmist, but it’s worth examining. Countries like Belgium and the Netherlands have expanded their euthanasia laws to include psychiatric conditions and, in some cases, minors. While these decisions come with safeguards, critics worry about the implications of normalizing such practices.
India, with its vast socio-economic disparities and deeply ingrained cultural taboos, is particularly vulnerable to misuse. For instance, could elderly individuals feel pressured into assisted dying because they are perceived as a financial burden? Could societal attitudes shift toward viewing death as a more “efficient” option for the poor and chronically ill?
The argument isn’t hypothetical. In countries where euthanasia is legal, there have been reported cases of families subtly influencing decisions or healthcare systems failing to explore other viable options before recommending assisted dying.
Fix the Living Before Discussing the Dying
Here’s the crux of the argument: societies need to prioritise caring for the living before offering pathways to death. In India, that means fixing palliative care.
How do we do that? For starters, we need government policies that prioritize palliative care funding, integrate it into the broader healthcare system, and make it available at the primary care level. Second, we need to train more professionals in end-of-life care. According to the Lancet Commission, there’s a severe global shortage of trained palliative care workers, and India is no exception.
Finally, we need cultural change. Talking about death in India often feels like inviting bad luck. We need public awareness campaigns to normalize discussions about end-of-life care, so families and patients know their rights and options.
The Moral Dilemma: To Choose or Not to Choose?
Ultimately, assisted dying is about choice. It’s about giving terminally ill individuals the autonomy to decide how and when they leave this world. But true autonomy isn’t possible in a system rife with inequities. Choice becomes a privilege, not a right, when access to healthcare is unequal.
The debate, therefore, isn’t whether assisted dying is moral or ethical—it’s whether we’ve earned the right to legislate it. If millions of Indians still die in pain due to lack of care, can we really claim to offer dignity in death?
A Fork in the Road
The assisted dying debate forces us to confront uncomfortable truths about healthcare, inequality, and the value we place on life and death. In an ideal world, the choice to die with dignity should exist. But in our imperfect reality, legalizing assisted dying without fixing palliative care risks creating a system where the vulnerable are pushed toward death, not out of choice, but because they were failed by life.
Before India joins the global bandwagon of assisted dying, should we not first ensure that every citizen has the right to die with dignity—not through a quick injection but through compassionate, equitable care that makes every moment worth living?
